US8795703B2 - Stand-alone film and methods for making the same - Google Patents

Images

Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F13/02—Adhesive bandages or dressings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/56—Materials from animals other than mammals
  • A61K35/60—Fish, e.g. seahorses; Fish eggs
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F13/00—Bandages or dressings; Absorbent pads
  • A61F13/02—Adhesive bandages or dressings
  • A61F13/023—Adhesive bandages or dressings wound covering film layers without a fluid retention layer
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
  • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
  • A61K31/22—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acyclic acids, e.g. pravastatin
  • A61K31/225—Polycarboxylic acids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/335—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin
  • A61K31/35—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom
  • A61K31/352—Heterocyclic compounds having oxygen as the only ring hetero atom, e.g. fungichromin having six-membered rings with one oxygen as the only ring hetero atom condensed with carbocyclic rings, e.g. methantheline 
  • A61K31/353—3,4-Dihydrobenzopyrans, e.g. chroman, catechin
  • A61K31/355—Tocopherols, e.g. vitamin E
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
  • A61K38/12—Cyclic peptides, e.g. bacitracins; Polymyxins; Gramicidins S, C; Tyrocidins A, B or C
  • A61K38/13—Cyclosporins
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/12—Carboxylic acids; Salts or anhydrides thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/06—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite
  • A61K47/08—Organic compounds, e.g. natural or synthetic hydrocarbons, polyolefins, mineral oil, petrolatum or ozokerite containing oxygen, e.g. ethers, acetals, ketones, quinones, aldehydes, peroxides
  • A61K47/14—Esters of carboxylic acids, e.g. fatty acid monoglycerides, medium-chain triglycerides, parabens or PEG fatty acid esters
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
  • A61K9/0024—Solid, semi-solid or solidifying implants, which are implanted or injected in body tissue
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/06—Ointments; Bases therefor; Other semi-solid forms, e.g. creams, sticks, gels
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
  • A61L2/02—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using physical phenomena
  • A61L2/04—Heat
  • A61L2/06—Hot gas
  • A61L2/07—Steam
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
  • A61L2/02—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using physical phenomena
  • A61L2/08—Radiation
  • A61L2/081—Gamma radiation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
  • A61L2/02—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using physical phenomena
  • A61L2/08—Radiation
  • A61L2/087—Particle radiation, e.g. electron-beam, alpha or beta radiation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
  • A61L2/16—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using chemical substances
  • A61L2/20—Gaseous substances, e.g. vapours
  • A61L2/206—Ethylene oxide
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2/00—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor
  • A61L2/16—Methods or apparatus for disinfecting or sterilising materials or objects other than foodstuffs or contact lenses; Accessories therefor using chemical substances
  • A61L2/20—Gaseous substances, e.g. vapours
  • A61L2/208—Hydrogen peroxide
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
  • A61L27/3604—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix characterised by the human or animal origin of the biological material, e.g. hair, fascia, fish scales, silk, shellac, pericardium, pleura, renal tissue, amniotic membrane, parenchymal tissue, fetal tissue, muscle tissue, fat tissue, enamel
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
  • A61L27/52—Hydrogels or hydrocolloids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
  • A61L27/54—Biologically active materials, e.g. therapeutic substances
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/005—Ingredients of undetermined constitution or reaction products thereof
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/08—Materials for coatings
  • A61L31/10—Macromolecular materials
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
  • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
  • A61L31/145—Hydrogels or hydrocolloids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/04—Hollow or tubular parts of organs, e.g. bladders, tracheae, bronchi or bile ducts
  • A61F2/06—Blood vessels
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
  • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
  • A61F2250/0067—Means for introducing or releasing pharmaceutical products into the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2202/00—Aspects relating to methods or apparatus for disinfecting or sterilising materials or objects
  • A61L2202/20—Targets to be treated
  • A61L2202/24—Medical instruments, e.g. endoscopes, catheters, sharps
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/20—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing organic materials
  • A61L2300/22—Lipids, fatty acids, e.g. prostaglandins, oils, fats, waxes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/20—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices containing or releasing organic materials
  • A61L2300/252—Polypeptides, proteins, e.g. glycoproteins, lipoproteins, cytokines
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/404—Biocides, antimicrobial agents, antiseptic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/41—Anti-inflammatory agents, e.g. NSAIDs
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/412—Tissue-regenerating or healing or proliferative agents
  • A61L2300/414—Growth factors
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/42—Anti-thrombotic agents, anticoagulants, anti-platelet agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/60—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a special physical form
  • A61L2300/602—Type of release, e.g. controlled, sustained, slow
• • B—PERFORMING OPERATIONS; TRANSPORTING
  • B05—SPRAYING OR ATOMISING IN GENERAL; APPLYING FLUENT MATERIALS TO SURFACES, IN GENERAL
  • B05D—PROCESSES FOR APPLYING FLUENT MATERIALS TO SURFACES, IN GENERAL
  • B05D3/00—Pretreatment of surfaces to which liquids or other fluent materials are to be applied; After-treatment of applied coatings, e.g. intermediate treating of an applied coating preparatory to subsequent applications of liquids or other fluent materials
  • B05D3/06—Pretreatment of surfaces to which liquids or other fluent materials are to be applied; After-treatment of applied coatings, e.g. intermediate treating of an applied coating preparatory to subsequent applications of liquids or other fluent materials by exposure to radiation
  • B05D3/061—Pretreatment of surfaces to which liquids or other fluent materials are to be applied; After-treatment of applied coatings, e.g. intermediate treating of an applied coating preparatory to subsequent applications of liquids or other fluent materials by exposure to radiation using U.V.
  • B05D3/065—After-treatment
  • B05D3/067—Curing or cross-linking the coating

Definitions

• the present invention generally relates to stand-alone films, and more particularly to stand-alone films that are formed from fatty acids.
• Blunt dissection can be generally described as dissection accomplished by separating tissues along natural cleavage lines without cutting. Blunt dissection is executed using a number of different blunt surgical tools, as is understood by those of ordinary skill in the art. Blunt dissection is often performed in cardiovascular, colo-rectal, urology, gynecology, upper GI, and plastic surgery applications, among others.
• blunt dissection a small incision is made in the patient.
• Specially designed blunt dissection tools having small profiles are inserted through the incision to the desired location in the body. Longer tools may be used to access locations substantially distal from the incision, while shorter tools can be used to access locations closer to the incision.
• Surgical adhesion disease is a complex inflammatory disease in which tissues that normally remain separated in the body grow into each other as a result of surgical trauma. Conventional surgical methods make use of anti-adhesion barriers, such as Interceed® from Johnson & Johnson or Seprafilm® from Genzyme Corporation.
• Interceed® is a fabric relatively easy to apply and handle. However, effectiveness may be diminished when bleeding has not been completely controlled. Seprafilm® is widely used in general surgery. However, it is challenging for surgeons to apply and handle because of the film's tendency to easily break apart upon exposure to water due to their chemical make up and bio-dissolvable properties. The composition and structural properties of these bio-dissolvable products require that they be handled with dry hands or instruments, which can be difficult during most surgical intervention operations. Furthermore, many of these bio-dissolvable films are made intentionally thin to minimize tissue disruption and consequently end up being structurally weak (i.e., easily torn or folded during handling).
• Seprafilm® is composed of two chemically modified biopolymers, sodium hyaluronate (HA) and carboxymethylcellulose (CMC), reacted with an activating agent 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride (EDC) to form a water insoluble powder, hyaluronic acid-carboxymethylcellulose (HA-CMC).
• HA-CMC hyaluronic acid-carboxymethylcellulose
• biodegradable substances such as polymers, can cause inflammatory response due to either the parent substance or those substances formed during breakdown, and they may or may not be absorbed by tissues.
• the present invention relates to a bio-absorbable stand-alone film that can exhibit anti-inflammatory properties, non-inflammatory properties, and anti-adhesion properties, and the corresponding method of making.
• the stand-alone film is generally formed of a naturally occurring oil, or an oil composition formed in part of a naturally occurring oil.
• the oil composition can include a therapeutic agent component, such as a drug or other bioactive agent.
• the stand-alone film is implantable in a patient for short term or long term applications.
• the stand-alone film is a non-polymeric cross-linked gel derived at least in part from a fatty acid compound.
• cross-linked gel refers to a gel that is non-polymeric and is derived from an oil composition comprising molecules covalently cross-linked into a three-dimensional network by one or more of ester, ether, peroxide, and carbon-carbon bonds in a substantially random configuration.
• the oil composition comprises a fatty acid molecule, a glyceride, and combinations thereof.
• a stand-alone film includes a non-polymeric cross-linked gel material formed at least in part of a fatty acid compound or derivative or analog thereof.
• the fatty acid compound includes omega-3 fatty acid, fish oil fatty acid, free fatty acid, triglycerides, esters of fish oil, or a combination thereof.
• the fish oil fatty acid can include one or more of arachidic acid, gadoleic acid, arachidonic acid, eicosapentaenoic acid, docosahexaenoic acid or derivatives, analogs and pharmaceutically acceptable salts thereof.
• the free fatty acid can include one or more of butyric acid, caproic acid, caprylic acid, capric acid, lauric acid, myristic acid, palmitic acid, palmitoleic acid, stearic acid, oleic acid, vaccenic acid, linoleic acid, alpha-linolenic acid, gamma-linolenic acid, behenic acid, erucic acid, lignoceric acid, analogs and pharmaceutically acceptable salts thereof.
• the stand-alone film further includes a vitamin E compound forming a portion of the fatty acid compound.
• the vitamin E compound can include one or more of alpha-tocopherol, beta-tocopherol, delta-tocopherol, gamma-tocopherol, alpha-tocotrienol, beta-tocotrienol, delta-tocotrienol, gamma-tocotrienol, alpha-tocopherol acetate, beta-tocopherol acetate, gamma-tocopherol acetate, delta-tocopherol acetate, alpha-tocotrienol acetate, beta-tocotrienol acetate, delta-tocotrienol acetate, gamma-tocotrienol acetate, alpha-tocopherol succinate, beta-tocopherol succinate, gamma-tocopherol succinate, delta-tocopherol succinate, alpha-tocotrienol succinate, alpha-tocophe
• the fatty acid compound or derivative or analog thereof is cured to increase viscosity to form the film.
• the stand-alone film is cured using at least one curing method selected from a group of curing methods including application of UV light, application of heat, airflow, and reaction with a gas or chemical cross-linker. It should be noted that curing with respect to the present invention generally refers to thickening, hardening, or drying of a material brought about by heat, UV, or chemical means.
• the stand-alone film further includes a therapeutic agent.
• the therapeutic agent can include an agent selected from the group consisting of antioxidants, anti-inflammatory agents, anti-coagulant agents, drugs to alter lipid metabolism, anti-proliferatives, anti-neoplastics, tissue growth stimulants, functional protein/factor delivery agents, anti-infective agents, imaging agents, anesthetic agents, chemotherapeutic agents, tissue absorption enhancers, anti-adhesion agents, germicides, analgesics, prodrugs, and antiseptics.
• the therapeutic agent is combined with the fatty acid compound prior to formation of the film, resulting in the therapeutic agent being interspersed throughout the film.
• the therapeutic agent is applied to the film in the form of a coating.
• the stand-alone film is bioabsorbable.
• the stand-alone film can further maintain anti-adhesive properties.
• a method of forming a stand-alone film includes providing a chamber formed of flexible porous material and having an internal wall and filling the chamber with a fatty acid compound in liquid form.
• the method also includes curing the fatty acid compound proximal to the internal wall to form a film along the internal wall.
• the method further includes removing the fatty acid compound that remains in liquid form and separating the film from the internal wall of the flexible porous material creating a stand-alone film.
• the flexible material includes expanded polytetrafluoroethylene (ePTFE).
• the fatty acid compound includes omega-3 fatty acid, fish oil fatty acid, free fatty acid, triglycerides, esters of fish oil, or a combination thereof.
• the fish oil fatty acid can include one or more of arachidic acid, gadoleic acid, arachidonic acid, eicosapentaenoic acid, docosahexaenoic acid or derivatives, analogs and pharmaceutically acceptable salts thereof.
• the free fatty acid can include one or more of butyric acid, caproic acid, caprylic acid, capric acid, lauric acid, myristic acid, palmitic acid, palmitoleic acid, stearic acid, oleic acid, vaccenic acid, linoleic acid, alpha-linolenic acid, gamma-linolenic acid, behenic acid, erucic acid, lignoceric acid, analogs and pharmaceutically acceptable salts thereof.
• the method further includes mixing a vitamin E compound to form a portion of the fatty acid compound.
• the vitamin E compound can include one or more of alpha-tocopherol, beta-tocopherol, delta-tocopherol, gamma-tocopherol, alpha-tocotrienol, beta-tocotrienol, delta-tocotrienol, gamma-tocotrienol, alpha-tocopherol acetate, beta-tocopherol acetate, gamma-tocopherol acetate, delta-tocopherol acetate, alpha-tocotrienol acetate, beta-tocotrienol acetate, delta-tocotrienol acetate, gamma-tocotrienol acetate, alpha-tocopherol succinate, beta-tocopherol succinate, gamma-tocopherol succinate, delta-tocopherol succinate, alpha-tocotrienol succinate, beta-tocopherol succinate,
• the curing includes using at least one curing method selected from a group of curing methods including application of UV light, application of heat, airflow, and reaction with a gas or chemical cross-linker.
• the method further includes combining a therapeutic agent with the fatty acid compound.
• the therapeutic agent can be combined with the fatty acid compound prior to formation of the stand-alone film, interspersing the therapeutic agent throughout the stand-alone film.
• a therapeutic agent can be applied to the stand-alone film in the form of a coating.
• another method of forming a stand-alone film includes providing a fatty acid compound in liquid form and applying the fatty acid compound to a substrate. The method also includes curing the fatty acid compound to form the stand-alone film.
• the substrate includes expanded polytetrafluoroethylene (ePTFE) or polytetrafluoroethylene (PTFE).
• the fatty acid compound includes omega-3 fatty acid, fish oil fatty acid, free fatty acid, triglycerides, esters of fish oil, or a combination thereof.
• the fish oil fatty acid can include one or more of arachidic acid, gadoleic acid, arachidonic acid, eicosapentaenoic acid, docosahexaenoic acid or derivatives, analogs and pharmaceutically acceptable salts thereof.
• the free fatty acid can include one or more of butyric acid, caproic acid, caprylic acid, capric acid, lauric acid, myristic acid, palmitic acid, palmitoleic acid, stearic acid, oleic acid, vaccenic acid, linoleic acid, alpha-linolenic acid, gamma-linolenic acid, behenic acid, erucic acid, lignoceric acid, analogs and pharmaceutically acceptable salts thereof.
• the method further includes mixing a vitamin E compound to form a portion of the fatty acid compound.
• the vitamin E compound can include one or more of alpha-tocopherol, beta-tocopherol, delta-tocopherol, gamma-tocopherol, alpha-tocotrienol, beta-tocotrienol, delta-tocotrienol, gamma-tocotrienol, alpha-tocopherol acetate, beta-tocopherol acetate, gamma-tocopherol acetate, delta-tocopherol acetate, alpha-tocotrienol acetate, beta-tocotrienol acetate, delta-tocotrienol acetate, gamma-tocotrienol acetate, alpha-tocopherol succinate, beta-tocopherol succinate, gamma-tocopherol succinate, delta-tocopherol succinate, alpha-tocotrienol succinate, beta-tocopherol succinate,
• the curing includes using at least one curing method selected from a group of curing methods including application of UV light and application of heat.
• the UV light can also be applied to set the fatty acid compound by forming a skin on the top surface of the fatty acid compound in liquid form prior to additional curing.
• the method further includes combining a therapeutic agent with the fatty acid compound.
• a therapeutic agent can be combined with the fatty acid compound prior to formation of the stand-alone film, interspersing the therapeutic agent throughout the stand-alone film.
• a therapeutic agent can be applied to the stand-alone film in the form of a coating.
• the method further includes treating the fatty acid compound in liquid form prior to application to the substrate to form a pre-thickened fatty acid compound.
• the substrate has an indentation that is used as a mold to shape the stand-alone film.
• the method can further include the step of cutting the film to a desirable shape.
• a barrier layer includes a non-polymeric cross-linked gel formed at least in part of a fatty acid compound or derivative or analog thereof.
• the fatty acid compound includes omega-3 fatty acid, fish oil fatty acid, free fatty acid, triglycerides, esters of fish oil, or a combination thereof.
• the barrier layer can further include a therapeutic agent.
• the therapeutic agent includes an agent selected from the group consisting of antioxidants, anti-inflammatory agents, anti-coagulant agents, drugs to alter lipid metabolism, anti-proliferatives, anti-neoplastics, tissue growth stimulants, functional protein/factor delivery agents, anti-infective agents, imaging agents, anesthetic agents, chemotherapeutic agents, tissue absorption enhancers, anti-adhesion agents, germicides, analgesics, prodrugs, and antiseptics.
• a method of using a stand-alone film includes placing a stand-alone film in between two body tissues, wherein the stand-alone film is formed at least in part of a fatty acid compound or derivative or analog thereof.
• FIG. 1A is an exemplary illustration of a stand-alone film according to one embodiment of the present invention.
• FIG. 1B is an exemplary top-view illustration of a rectangular shaped stand-alone film in accordance with one embodiment of the present invention
• FIG. 1C is an exemplary top-view illustration of a triangular shaped stand-alone film in accordance with one embodiment of the present invention
• FIG. 1D is an exemplary top-view illustration of a circular shaped stand-alone film in accordance with one embodiment of the present invention
• FIG. 1E is an exemplary top-view illustration of a custom shaped stand-alone film in accordance with one embodiment of the present invention.
• FIG. 2 is a flowchart illustrating a method of creating a stand-alone film from fatty acid compound in liquid form according to another embodiment of the present invention
• FIG. 3A is a cross-sectional illustration of a fatty acid compound disposed on top of a flat substrate according to one embodiment of the present invention
• FIG. 3B is an exemplary Petri dish that is suitable for use in forming the stand-alone film in accordance with one embodiment of the present invention
• FIG. 3C is a cross-sectional illustration of a fatty acid compound disposed in a Petri dish with a cover according to one embodiment of the present invention.
• FIG. 3D is a cross-sectional illustration of a fatty acid compound disposed in a mold according to one embodiment of the present invention.
• FIG. 4 is a flowchart illustrating a method of creating a stand-alone film from fatty acid compound in liquid form according to one embodiment of the present invention
• FIG. 5 is another illustration of a stand-alone film formed from using a tube substrate according to one embodiment of the present invention.
• FIG. 6A is a graph showing tensile strength as a function of treatment time when a film was processed at 200° F.
• FIG. 6B is a graph showing tensile strength as a function of processing temperature
• FIG. 7 is a graph showing the amount of a therapeutic agent released from a fish oil film sample as a function of time when the therapeutic agent was loaded into the film;
• FIG. 8 is a graph showing the amount of a therapeutic agent released from a fish oil film sample as a function of time when the therapeutic agent was coated onto the film using an overlaying method.
• FIG. 9 is a graph showing the amount of a therapeutic agent released from a fish oil film sample as a function of time when the film was dipped into a solution containing the therapeutic agent and allowed to swell.
• the present invention utilizes primarily fatty acids to form a stand-alone film.
• the phrase stand-alone film is used herein to refer to a film that does not require any additional material to provide structure to the film.
• a medical device having a coating of fish oil is not a stand-alone film because the coating of fish oil relies on the device to provide structure to the film.
• the stand-alone films are bioabsorbable and cells may consume the breakdown products, fatty acid, short and long chain alcohol, and glyceride molecules. Bioabsorbable substances break down into substances or components that do not cause an inflammatory response and can be consumed by the cells forming the body tissues.
• the resultant film is flexible, easy to handle, and relatively strong. The resultant film may be used with many surgical procedures when anti-adhesion is desirable for a pre-determined amount of time.
• FIGS. 1A through 10 illustrate example embodiments of a non-polymeric stand-alone film and the method of making according to the present invention.
• FIG. 1A illustrates an exemplary stand-alone film 100 according to one embodiment of the present invention.
• the stand-alone film 100 is flexible, to the extent that it can be placed in a flat, curved, or rolled configuration within a patient.
• the stand-alone-film 100 is implantable, for both short term and long term applications.
• the stand-alone film 100 has a thickness 102 in the range of 0.003 inches to 0.008 inches.
• thicker films may be made from layering several stand-alone films 100 together, or the film itself may be made thicker.
• Thickness 102 is positively proportional to the time it takes for the stand-alone film 100 to breakdown in a patient's body. In other words, the thicker the stand-alone film 100 is, the longer it takes for the stand-alone film 100 to completely breakdown in the patient's body.
• the stand-alone film 100 may be constructed to provide a barrier for a predetermined period of time, such as, but not limited to, a period of hours, a period of weeks, or a period of months.
• Stand-alone film 100 is made from fatty acids, such as omega-3 fatty acid, fish oil fatty acid, free fatty acid, triglycerides, esters of fish oil, or a combination thereof.
• Fish oil fatty acid may further be one or a combination of arachidic acid, gadoleic acid, arachidonic acid, eicosapentaenoic acid, docosahexaenoic acid or derivatives, analogs, and pharmaceutically acceptable salts thereof.
• Free fatty acid may be one or more of butyric acid, caproic acid, caprylic acid, capric acid, lauric acid, myristic acid, palmitic acid, palmitoleic acid, stearic acid, loeic acid, vaccenic acid, linoleic acid, alpha-linolenic acid, gamma-linolenic acid, behenic acid, erucic acid, lignoceric acid, or derivatives, analogs and pharmaceutically acceptable salts thereof.
• the stand-alone film 100 is formed of a non-polymeric cross-linked gel derived from fatty acid compounds.
• the fatty acids include omega-3 fatty acids when the oil utilized to form the stand-alone film is fish oil or an analog or derivative thereof.
• autoxidation occurs with the absorption of oxygen into the fish oil to create hydroperoxides in an amount dependent upon the amount of unsaturated (C ⁇ C) sites in the fish oil.
• the (C ⁇ C) bonds are not consumed in the initial reaction.
• Concurrent with the formation of hydroperoxides is the isomerization of (C ⁇ C) double bonds from cis to trans in addition to double bond conjugation. It has been demonstrated that hydroperoxide formation increases with temperature.
• Heating of the fish oil allows for cross-linking between the fish oil unsaturated chains using a combination of peroxide (C—O—O—C), ether (C—O—C), and hydrocarbon (C—C) bridges.
• C—O—O—C peroxide
• ether C—O—C
• C—C hydrocarbon
• the formation of the cross-links results in gelation of the film after the (C ⁇ C) bonds have substantially isomerized into the trans configuration.
• the (C ⁇ C) bonds can also form C—C cross-linking bridges in the glyceride hydrocarbon chains using a Diels-Alder Reaction.
• both the hydroperoxide and (C ⁇ C) bonds can undergo secondary reactions converting them into lower molecular weight secondary oxidation byproducts including aldehydes, ketones, alcohols, fatty acids, esters, lactones, ethers, and hydrocarbons.
• the film derived from fatty acid compounds includes a cross-linked structure of triglyceride and fatty acid molecules in addition to free and bound glycerol, monoglyceride, diglyceride, and triglyceride, fatty acid, anhydride, lactone, aliphatic peroxide, aldehyde, and ketone molecules.
• glycerol monoglyceride
• diglyceride diglyceride
• triglyceride fatty acid
• anhydride lactone
• aliphatic peroxide aldehyde
• ketone molecules ketone molecules.
• ester bonds remaining after curing in addition to peroxide linkages forming the majority of the cross-links in the film.
• the film degrades into fatty acid, short and long chain alcohol, and glyceride molecules, which are all non-inflammatory and likewise consumable by cells in the soft tissue to which the film is applied.
• the film is bioabsorbable.
• the stand-alone film 100 further provides a lubricious and anti-adhesive surface against tissue.
• the stand-alone film itself, in its substantially cured configuration, can provide a physical anti-adhesion barrier between two sections of tissue.
• the use of the naturally occurring oil, such as fish oil, provides extra lubrication to the surface of the film, which helps to reduce injury. With less injury, there is less of an inflammatory response, and less healing required.
• the oily surface of the film provides the anti-adhesion characteristics.
• oils will have different anti-adhesive properties, and the oils can be modified to be more liquefied or more solid or waxy, as desired.
• the degree of anti-adhesive properties offered by the film can vary.
• the modification of the oils from a more liquid physical state to a more solid, but still flexible, physical state is implemented through the curing process.
• the oils are cured, especially in the case of fatty acid-based oils such as fish oil, cross-links form creating a gel.
• the curing process is performed over increasing time durations and/or increasing temperature conditions and/or increasing UV output, more cross-links form transitioning the gel from a relatively liquid gel to a relatively solid-like, but still flexible, gel structure.
• the stand-alone film 100 can further include a therapeutic agent.
• the therapeutic agent can include an agent selected from the group consisting of antioxidants, anti-inflammatory agents, anti-coagulant agents, drugs to alter lipid metabolism, anti-proliferatives, anti-neoplastics, tissue growth stimulants, functional protein/factor delivery agents, anti-infective agents, imaging agents, anesthetic agents, chemotherapeutic agents, tissue absorption enhancers, anti-adhesion agents, germicides, analgesics, prodrugs, and antiseptics.
• the therapeutic agent may be added to the fatty acid compound prior to forming a stand-alone film so that the therapeutic agent is interspersed throughout the stand-alone film 100 .
• the therapeutic agent may be applied to the stand-alone film 100 to form a coating on a surface of the stand-alone film after the fatty acid compound has formed a stand-alone film.
• the therapeutic agent can include a vitamin E compound.
• the vitamin E compound may include one or more of alpha-tocopherol, beta-tocopherol, delta-tocopherol, gamma-tocopherol, alpha-tocotrienol, beta-tocotrienol, delta-tocotrienol, gamma-tocotrienol, alpha-tocopherol acetate, beta-tocopherol acetate, gamma-tocopherol acetate, delta-tocopherol acetate, alpha-tocotrienol acetate, beta-tocotrienol acetate, delta-tocotrienol acetate, gamma-tocotrienol acetate, alpha-tocopherol succinate, beta-tocopherol succinate, gamma-tocopherol succinate, delta-tocopherol succinate, alpha-tocotrienol succinate, beta-tocotrienol succinate, delta-tocopherol succinate, al
• the stand-alone film of the present invention may be applied with other therapeutic agents that are not listed above. These therapeutic agents are added for healing purposes and not to provide structure to the stand-alone film.
• the stand-alone film can be formed in a manner that creates the potential for controlled long term release of a therapeutic agent, while still maintaining the benefits of the natural oil component of the film.
• the uptake of the therapeutic agent is facilitated by the delivery of the therapeutic agent to the cell membrane by the bio-absorbable stand-alone film.
• the stand-alone film 100 can be formed in many different shapes.
• the stand-alone film 100 can have a rectangular shape with square corners as illustrated in FIG. 1B .
• the stand-alone film 100 can have a triangular shape with round corners as illustrated in FIG. 1C .
• the stand-alone film 100 can have a circular shape as illustrated in FIG. 1D .
• the stand-alone film 100 can have a custom shape as illustrated in FIG. 1E .
• FIG. 2 is a flowchart illustrating a method of creating a stand-alone film from a fatty acid compound in liquid form according to one embodiment of the present invention.
• a fatty acid compound in liquid form is provided in step 210 .
• the fatty acid compound is optionally treated to increase viscosity in step 211 .
• the viscosity of the fatty acid compound is raised to the point where the thickened fatty acid compound can be cast onto the substrate without the risk of immediate pooling or running of the fatty acid compound.
• the fatty acid compound is then applied to a substrate in step 212 . If the fatty acid compound is in liquid form, the fatty acid compound may simply be poured onto the substrate.
• Instruments can be used to help spread the fatty acid compound on the substrate surface. If the fatty acid compound is of increased viscosity, the fatty acid compound can be applied to a substrate with the assistance of a casting knife. One of ordinary skill in the art will appreciate that there are many methods to apply compounds on to a substrate, and the specific methods mentioned here are not meant to limit the scope of the present invention.
• the fatty acid compound on the substrate is then treated to form a stand-alone film in step 214 .
• the treating methods can include, but are not limited to, application of UV light, application of heat, airflow, and reaction with a gas or chemical cross-linker.
• FIGS. 3A-3D are exemplary substrates that are suitable to practice one embodiment of the present invention using the flowchart in FIG. 2 .
• FIG. 3A is a cross-sectional illustration of a fatty acid compound disposed on top of a flat substrate according to one embodiment of the present invention.
• fatty acid compound 122 is pre-treated to increase the viscosity of the fatty acid compound 122 until a gelation process of the fatty acid compound 122 has started.
• the thickened fatty acid compound 122 is then applied directly on top of a flat non-porous substrate 120 using a controlled applicator, such as micrometer controlled film casting knife, spin casting, and the like.
• the flat non-porous substrate 120 with the thickened fatty acid compound 122 on top is then subjected to UV light exposure for a short period of time, such as, about 10-20 minutes, to set the film and prevent running of the fatty acid compound 122 at the elevated curing temperature.
• the fatty acid compound 122 on the flat non-porous substrate is then placed into an oven for a period of time at a set temperature, such as, a minimum of 12 hours at 200° F., to complete the curing process.
• the resultant film is removed from the flat non-porous substrate 120 to form a stand-alone film.
• FIG. 3B is an exemplary Petri dish that is suitable to practice one embodiment of the present invention.
• Petri dish 112 is a shallow cylindrical dish made of plastic or glass.
• the Petri dish 112 is filled half way with fatty acid compound 114 and then covered with a cover 116 made of porous material, such as shown in FIG. 3C .
• the Petri dish 112 is turned upside down (cover 116 side down) and placed into an oven.
• the temperature of the oven can be between 100° F. and 250° F.
• the Petri dish is left in the oven for a desired amount of time at a set temperature, such as a minimum of 12 hours at 200° F.
• the Petri dish 112 After the Petri dish 112 has been in the oven for the desired amount of time, the Petri dish 112 is removed from the oven and kept upside down to allow the fatty acid compound 114 to cool to room temperature. When the fish oil has sufficiently cooled, the cover 116 is pierced near the edge to allow excess fish oil to drain out. Thus, a semi-cured layer of film is left behind on the cover 116 .
• the Petri dish 112 , along with the cover 116 and the semi-cured film are then placed back into the oven for a predetermined amount of time at a set temperature, such as a minimum of 4 hours at 200° F. to finish the curing process. After the film is completely cured, the Petri dish 112 is removed from the oven and allowed to cool. When the Petri dish 112 is cooled, the cover 116 is removed from the dish and the film is peeled away from the cover 116 to form a stand-alone film.
• FIG. 3D is a cross-sectional illustration of a fatty acid compound disposed in a mold.
• Mold 118 is a flat substrate with a slight indentation into which the fatty acid compound 117 is applied.
• the mold may be used to shape the resultant stand-alone film. Additionally, patterns or words may be included in the mold to identify certain properties or features of the stand-alone films, such as names of one or more therapeutic agents that are included in the film, or the side of the film that has a coating of one or more therapeutic agents, thickness of the film, name of the company that produces the films, and etc.
• sheets of stand-alone films can be cut to different shapes prior to shipping the stand-alone films to customers. In this manner, customers can choose to purchase different shapes of films for different purposes. This provides the surgeons the convenience to use pre-cut films that are suitable for different surgeries.
• FIG. 4 is a flowchart illustrating a method of creating a stand-alone film using a tube structure, such as shown in FIG. 5 .
• a chamber formed of flexible porous material and having an internal wall, such as tube structure 124 is provided.
• the chamber is filled with fatty acid compound in liquid form in step 202 .
• the tube is heated, such as at 100° F. to 300° F. in an oven for a desired amount of time, such as 12 hours to 6 weeks.
• the fatty acid compound is cured proximal to the internal wall of the chamber to form a film along the internal wall in step 204 .
• a thin film 126 is formed on the internal wall of the tube structure 124 .
• any excess fatty acid compound in liquid form is removed in step 206 .
• excess fatty acid compound in liquid form may be drained or poured out from tube structure 124 .
• the film formed along the internal wall of the tube structure is separated from the internal wall to create a stand-alone film in step 208 .
• any tubing material that is flexible and porous, yet not allow liquid to penetrate may be used in the present invention, such as expanded polytetrafluoroethylene and expanded Ultra High Molecular Weight Polyethylene.
• omega-3 fatty acid which can act as an anti-inflammatory agent.
• Other therapeutic agents may also be utilized to enhance this feature.
• Therapeutic agents may also be added to a stand-alone film made of fatty acids to provide additional healing functions, such as through drug loading or drug coating.
• therapeutic agent(s) refers to a number of different drugs or agents available, as well as future agents that may be beneficial for use with the stand-alone film of the present invention.
• the therapeutic agent can take a number of different forms including anti-oxidants, anti-inflammatory agents, anti-coagulant agents, drugs to alter lipid metabolism, anti-proliferatives, anti-neoplastics, tissue growth stimulants, functional protein/factor delivery agents, anti-infective agents, anti-imaging agents, anesthetic agents, therapeutic agents, tissue absorption enhancers, anti-adhesion agents, germicides, anti-septics, analgesics, prodrugs, and any additional desired therapeutic agents such as those listed in Table 1 below.
• statins atorvastatin, amlopidine ACE Inhibitors Elanapril, fosinopril, cilazapril Antihypertensive Agents Prazosin, doxazosin Antiproliferatives and Cyclosporine, cochicine, mitomycin C, Antineoplastics sirolimus micophenonolic acid, rapamycin, everolimus, tacrolimus, paclitaxel, QP-2, actinomycin, estradiols, dexamethasone, metha- trexate, cilostazol, prednisone, cyclosporine, doxorubicin, ranpirnas, troglitzon, valsart, pemirolast, C-MYC antisense, angiopeptin, vincristine, PCNA ribozyme, 2-chloro-deoxyadenosine Tissue growth stimulants Bone morphogeneic protein, fibroblast growth factor Promotion of hollow Alcohol
• therapeutic agents useful in the anti-restenosis realm include cerivastatin, cilostazol, fluvastatin, lovastatin, paclitaxel, pravastatin, rapamycin, a rapamycin carbohydrate derivative (for example, as described in US Patent Application Publication 2004/0235762), a rapamycin derivative (for example, as described in U.S. Pat. No. 6,200,985), everolimus, seco-rapamycin, seco-everolimus, and simvastatin.
• the therapeutic agent is administered orally or intravenously to be systemically processed by the patient.
• an alternative to the systemic administration of a therapeutic agent is the use of a targeted local therapeutic agent delivery approach.
• the therapeutic agent is administered using a medical device or apparatus, directly by hand, or sprayed on the tissue, at a selected targeted tissue location of the patient that requires treatment.
• the therapeutic agent emits, or is otherwise delivered, from the medical device apparatus, and/or carrier, and is applied to the targeted tissue location.
• the local delivery of a therapeutic agent enables a more concentrated and higher quantity of therapeutic agent to be delivered directly at the targeted tissue location, without having broader systemic side effects.
• the therapeutic agent that escapes the targeted tissue location dilutes as it travels to the remainder of the patient's body, substantially reducing or eliminating systemic side effects.
• Targeted local therapeutic agent delivery using a medical device can be further broken into two categories, namely, short term and long term ranging generally within a matter of seconds or minutes to a few days or weeks to a number of months.
• the therapeutic agent must be combined with a delivery agent, or otherwise formed with a physical impediment as a part of the medical device, to slow the release of the therapeutic agent.
• Prior attempts to create films and drug delivery platforms such as in the field of stents, primarily make use of high molecular weight synthetic polymer based materials to provide the ability to better control the release of the therapeutic agent.
• the polymer in the platform releases the drug or agent at a predetermined rate once implanted at a location within the patient. Regardless of how much of the therapeutic agent would be most beneficial to the damaged tissue, the polymer releases the therapeutic agent based on properties of the polymer.
• the effect of the therapeutic agent is substantially local at the surface of the tissue making contact with the medical device having the coating. In some instances the effect of the therapeutic agent is further localized to the specific locations of, for example, stent struts or mesh pressed against the tissue location being treated.
• the stand-alone film 100 of the present invention makes use of the natural oils to form a non-polymeric natural oil based therapeutic agent delivery platform, if desired. Furthermore, the stand-alone film 100 can be formed in a manner that creates the potential for controlled long term release of a therapeutic agent, while still maintaining the benefits of the natural oil component of the stand-alone film 100 .
• a therapeutic agent is combined with a fatty acid compound prior to formation of the film in accordance with one embodiment of the present invention.
• the resultant film has the therapeutic agent interspersed throughout the film.
• a therapeutic agent is applied in the form of a coating on a stand-alone film.
• a coating can be applied by overlaying a drug-loaded fatty acid compound on a stand-alone film.
• a therapeutic agent is dissolved in an appropriate solvent, it is blended with a fatty acid compound to form a coating material.
• the solvent is evaporated prior to applying the coating material as a coating on a stand-alone film.
• the therapeutic agent may be blended directly into the fatty acid compound without the use of a solvent.
• the coating material can be, for example, sprayed or brushed onto a stand-alone film.
• the coating material can also be cast directly on top of a stand-alone film.
• the stand-alone film with the coating material is heated or exposed to UV light to raise the viscosity of the coating material beyond the gelation point and hence create a cross-linked gel coating on the stand-alone film.
• the coating material can be left in a state of lower viscosity to preserve drug recovery rate or to alter the release characteristics of the therapeutic agent used in the coating material.
• a coating can be applied using a polyionic layer-by-layer (LBL) technique.
• a stand-alone film is contacted by a cationic solution (+ charged) for a period of time, after which the stand-alone film is rinsed with deionized water. This results in the stand-alone film being added with a layer of positively charged polyelectrolyte coating.
• Another layer of coating is then applied by contacting the stand-alone film with an anionic solution ( ⁇ charged) for a period of time, after which the stand-alone film is again rinsed with deionized water.
• concentration of the polyelectrolytes can be varied.
• a therapeutic agent is coated onto the stand-alone film by substituting the therapeutic agent for one of the polyelectrolyte components of the LBL system. After the therapeutic agent is applied, the stand-alone film may be rinsed with deionized water. Using this general procedure, a single drug layer can be coated on the surface of the stand-alone film. Alternatively, a capping polyelectrolyte bilayer can be applied after the drug is coated onto the surface of the stand-alone film and the procedure can be repeated several times to create multiple buried drug layers.
• a coating can be applied by dipping a stand-alone film in a solvent-therapeutic mixture to load the therapeutic agent onto the stand-alone film.
• a therapeutic agent is dissolved in an appropriate solvent.
• the stand-alone film is then dipped into the solution for a period of time to coat the surface of the film or to allow the film to swell and absorb some of the solution.
• the stand-alone film is then removed and the solvent in the film is evaporated.
• solvents that may be used with this method include, but are not limited to, ethanol and nMP.
• the stand-alone film of the present invention may be used as a barrier to keep tissues separated to avoid adhesion.
• Application examples for adhesion prevention include abdominal surgeries, spinal repair, orthopedic surgeries, tendon and ligament repairs, gynecological and pelvic surgeries, and nerve repair applications.
• the stand-alone film may be applied over the trauma site or wrapped around the tissue or organ to limit adhesion formation.
• the addition of therapeutic agents to the stand-alone films used in these adhesion prevention applications can be utilized for additional beneficial effects, such as pain relief or infection minimization.
• Other surgical applications of the stand-alone film may include using a stand-alone film as a dura patch, buttressing material, internal wound care (such as a graft anastomotic site), and internal drug delivery system.
• the stand-alone film may also be used in applications in transdermal, wound healing, and non-surgical fields.
• the stand-alone film may be used in external wound care, such as a treatment for burns or skin ulcers.
• the stand-alone film may be used without any therapeutic agent as a clean, non-permeable, non-adhesive, non-inflammatory, anti-inflammatory dressing, or the stand-alone film may be used with one or more therapeutic agents for additional beneficial effects.
• the stand-alone film may also be used as a transdermal drug delivery patch when the stand-alone film is loaded or coated with one or more therapeutic agents.
• the process of wound healing involves tissue repair in response to injury and it encompasses many different biologic processes, including epithelial growth and differentiation, fibrous tissue production and function, angiogenesis, and inflammation.
• the cross-linked gel used to make the inventive stand-alone film has been shown in an animal model not to produce an inflammatory response, but still provide excellent cellular overgrowth with little to no fibrous capsule formation. Accordingly, the stand-alone film provides an excellent material suitable for wound healing applications.
• FIG. 6A demonstrates the increase in tensile strength of 5-mil-thick films as a function of processing time at 200° F. All films were cast from pre-thickened fish oil ( ⁇ 15,500 cP @ 24° C.) onto a PTFE mat and placed under UV lamps (15 watts and 254 nm) for 15 minutes.
• FIG. 6B illustrates variations in tensile strength as a function of processing temperature. All films were cast from pre-thickened fish oil ( ⁇ 15,500 cP @ 24° C.) onto a PTFE mat and placed under UV lamps (15 watts and 254 nm) for 15 minutes. The films were then heated in an oven with a set temperature of either 200° F. or 300° F. The films were heated for 24 hours and 48 hours and the tensile strength were measured as shown in FIG. 6B .
• One of ordinary skill in the art will appreciate that many factors can vary film performance, such as the time and temperature of the heating treatment, the time and intensity of the UV treatment, the type of fatty acid compound used, and any therapeutic agent that is added to the film.
• the stand-alone film of the present invention has shown improved tensile strength properties compared to Seprafilm® manufactured by Genzyme Corporation.
• the tensile strength is about 13.5 lbf.
• Seprafilm's tensile strength reduces to 0.059 lbf due to hydration.
• a stand-alone film in accordance with the present invention with a thickness that is about the same as Seprafilm has a tensile strength of 0.48 lbf (when the film was made using the same process as the samples shown in FIG.
• the stand-alone film can provide improved anti-adhesion protection compared to Seprafilm.
• Seprafilm is designed to degrade within about 7 days, whereas the stand-alone film of the present invention can be designed to degrade in a period of weeks to months.
• the stand-alone film can be used to provide longer anti-adhesion protection where adhesion is likely to occur after 7 days.
• Seprafilm loses its tensile strength dramatically when it encounters moisture, it is difficult to handle Seprafilm before and during the process of implantation.
• the tensile strength of a stand-alone film of the present invention does not change with moisture in a short period of time, such as within 30 seconds.
• the stand-alone film is substantially easier to handle.
• a stand-alone film using the methods shown in FIG. 2 with a flat substrate, such as shown in FIG. 3A was demonstrated using a polytetrafluoroethylene (PTFE) substrate.
• PTFE polytetrafluoroethylene
• EPAX 3000 TG fish oil was heated at 200° F. for a week until the viscosity of the fish oil reaches 15,500 cps at 24° C.
• the thickened fish oil was cast directly onto a mat of PTFE by using a controlled applicator, such as a micrometer controlled film casting knife with a gap setting of 0.0015 inches.
• the PTFE mat with the thickened fish oil on top was then placed under a UV lamp for 15 minutes.
• the UV lamp had a power of 15 watts and emitted UV light with a 254 nm wavelength. After exposing the thickened fish oil to UV light, it was then heated in an oven at 200° F. for 24 hours to completely cure the thickened fish oil. The resultant film was removed from the PTFE mat to form a stand-alone film. The film's thickness was measured to be 0.005 inches using a snap gauge. The film was soft, flexible, durable and easy to handle with bare hands or gloves.
• FIG. 2 Another example of making a stand-alone film using the method shown in FIG. 2 and a substrate such as those shown in FIGS. 3B and 3C was demonstrated using a Pyrex Petri dish.
• the Pyrex Petri dish was filled half way with fish oil and then covered with an ePTFE cover, where the ePTFE material had an internodal distance of between 5 to 20 microns.
• the Petri dish was turned upside down (ePTFE side down) and placed into an oven. The temperature of the oven was set to 200° F. The Petri dish was left in the oven for 24 hours. After the Petri dish had been in the oven for the desired amount of time, the Petri dish was removed from the oven and kept upside down to allow the fish oil to cool to room temperature.
• the ePTFE cover When the fish oil had cooled down, the ePTFE cover was pierced near the edge to allow excess fish oil to drain out. Thus, a semi-cured layer of film was left behind on the ePTFE cover.
• the Petri dish, along with the ePTFE cover and the semi-cured film were then placed back into the oven for 4 hours to finish the curing process. After the film was completely cured, the Petri dish was removed from the oven and allowed to cool. When the Petri dish was cooled, the ePTFE cover was removed from the dish and the film was peeled away from the ePTFE cover to form a stand-alone film.
• ePTFE expanded polytetrafluoroethylene
• the ePTFE material has an internodal distance of between 5 to 20 microns.
• EPAX® fish oil from Pronova Biocare was used to fill the ePTFE tube.
• the filled ePTFE tube was then placed in the oven for 48 hours at 200° F.
• the heated ePTFE tube was then removed from the oven and any excess fish oil was drained.
• a thin film was left behind on the tube internal wall surface after draining the excess fish oil.
• the ePTFE tube was cut open lengthwise and the film was peeled from the internal wall of the ePTFE tube to form a stand-alone film.
• Cyclosporine One example of using drug loading was demonstrated by using Cyclosporine. Pure fish oil was heated at 200° F. to obtain a viscosity of 15,000-20,000 cps at 24° C. to form a pre-treated or pre-thickened fish oil. 3.1 g of the pre-treated or pre-thickened fish oil is then mixed with 64.6 mg of Cyclosporine A (CSA). The mixture was then heated to 150° F. for 20 minutes to allow the CSA to dissolve in the fish oil. This resulted in a 2.0% CSA in fish oil formulation by weight. After heating, the mixture was cast onto a Teflon mat with a casting knife to form a thin film. The thin film was then placed under a UV lamp for 15 minutes.
• CSA Cyclosporine A
• the UV lamp had a power of 15 watts and emitted UV light with a 254 nm wavelength.
• the thin film was heated in an oven at 200° F. for 24 hours, after which the thin film was removed from the oven and allowed to cool for 1 hour. After the thin film was cooled, it was peeled from the Teflon mat to form a stand-alone film.
• the resultant film had a thickness of approximately 0.005′′.
• Drug extraction and dissolution were performed on the film by high performance liquid chromatography (HPLC).
• HPLC high performance liquid chromatography
• the extraction result shows a CSA load of 311 ⁇ g on a 1′′ by 1′′ sample.
• the dissolution results are shown in FIG. 7 . In general, the dissolution results showed that CSA was released in an approximately linear fashion as a function of time.
• a coating of Marcaine was added to a piece of stand-alone film by applying a polyelectrolyte coating (LBL) on a 1′′ by 11 ⁇ 2′′ of stand-alone film.
• the cationic component was 0.01M polyethylene amine (PEI) while the anionic component was 0.01M poly acrylic acid (PAA).
• a 10-layer system was added to the stand-alone film beginning with PEI and ending with PAA, with a 5-minute soak for each component followed by a deionized water rinse. 103.2 mg of Marcaine was added to 3.5 ml of water to form a 29.5 mg/ml Marcaine solution.
• the stand-alone film was then dipped into the Marcaine solution for 5 minutes and allowed to air dry.
• Still another example of drug coating was demonstrated by allowing a stand-alone film to swell with a solution including a therapeutic agent.
• 40.1 mg of RAP was mixed with 3.6 g of EtOH. This resulted in a 10% RAP in Ethanol formulation by weight.
• a 1′′ by 11 ⁇ 2′′ of stand-alone film was dipped into the RAP formulation and allowed to swell. The stand-alone film was then allowed to air dry. The resultant film was approximately 0.005′′ in thickness.
• Drug extraction and dissolution were performed on the film by HPLC. The extraction result shows a RAP load of 4.7 mg on a 1′′ by 11 ⁇ 2′′ sample. Dissolution results are shown in FIG. 9 .
• the film may start to wrinkle during the curing process or the fish oil may flow and run off the substrate when the substrate is not perfectly leveled in the oven.
• the resultant film may be of poor quality or may not be reproduced consistently when certain substrates are used.
• a porous substrate such as ePTFE
• liquid fish oil or a non-porous substrate with a pre-thickened fish oil can resolve the above mentioned difficulties. Liquid fish oil penetrates into the porous substrate and thus creates a mechanical lock during the curing process to prevent the film from wrinkling.
• any drying or semi-drying oils may also be used with a porous substrate.
• Using a pre-thickened fish oil on a non-porous substrate provides a different surface tension between the fish oil and the substrate so that the thickened fish oil may be spread out evenly on the substrate.
• the present invention provides methods for making stand-alone films from fatty acids.
• the bioabsorbable nature of the stand-alone film results in the film being completely absorbed over time by the cells of the body tissue. There is no breakdown of the stand-alone film into components and substances that are inflammatory and are eventually distributed throughout the body and in some instances disposed of by the body, as in the case with biodegradable synthetic polymer surgical films.
• the stand-alone film also provides a lubricious or anti-adhesive surface against body tissues.
• the fatty acid derived cross-linked gel that makes up the stand-alone film maintains anti-inflammatory and/or non-inflammatory properties that helps lower the inflammatory response of the body tissues. The reduced inflammation also reduces adhesions.
• a stand-alone film made from fatty acid compounds is flexible, easy to handle, and can be shaped easily.
• a therapeutic agent may be applied to a stand-alone film through drug loading or drug coating.
• the stand-alone film not only provides anti-adhesion but also therapeutic healing functions.

Landscapes

• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Chemical & Material Sciences (AREA)
• Epidemiology (AREA)
• Medicinal Chemistry (AREA)
• Engineering & Computer Science (AREA)
• Pharmacology & Pharmacy (AREA)
• Chemical Kinetics & Catalysis (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Vascular Medicine (AREA)
• General Chemical & Material Sciences (AREA)
• Dermatology (AREA)
• Surgery (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Transplantation (AREA)
• Oil, Petroleum & Natural Gas (AREA)
• Dispersion Chemistry (AREA)
• Molecular Biology (AREA)
• Botany (AREA)
• Neurosurgery (AREA)
• Proteomics, Peptides & Aminoacids (AREA)
• Emergency Medicine (AREA)
• Immunology (AREA)
• Gastroenterology & Hepatology (AREA)
• Bioinformatics & Cheminformatics (AREA)
• Marine Sciences & Fisheries (AREA)
• Urology & Nephrology (AREA)
• Zoology (AREA)
• Materials For Medical Uses (AREA)
• Medicinal Preparation (AREA)
• Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
• Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
• Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

Description

Claims (33)

Priority Applications (13)

Applications Claiming Priority (2)

Related Parent Applications (2)

Related Child Applications (8)

Publications (2)

Family

ID=36119534

Family Applications (8)

Family Applications Before (2)

Family Applications After (5)

Country Status (3)

Cited By (1)

Families Citing this family (54)

Citations (264)

Family Cites Families (275)